Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study.

Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.

Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study.

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

Psychiatric comorbidity and familial factors in childhood epilepsy: Parental psychopathology, coping strategies, and family functioning.

OBJECTIVE: This study aimed to examine the psychiatric diagnoses, parenting attitudes, family functioning among children and adolescents with epilepsy, coping styles of their mothers, and psychiatric symptoms of their mothers and fathers. METHODS: Forty children and adolescents between the ages of 8 and 18 with epilepsy and 40 healthy controls were included in the study. The clinical interview and other measurements were used to assess psychiatric disorders and familial factors. RESULTS: At least one psychiatric disorder was diagnosed in 65% of children and adolescents with epilepsy. It was determined that the mothers and fathers in the epilepsy group had higher anxiety and depression scores than the control group, and the fathers' hostility scores were also higher. The Family Assessment Device (FAD) (problem-solving and affective responsiveness), Coping Strategies Scale (COPE) (mental disengagement and substance use), and Parent Attitude Scale (PAS) (strictness/supervision) subtest scores of the epilepsy group were higher than the control group. CONCLUSION: Psychiatric comorbidities, especially depression, anxiety disorders, and attention deficit hyperactivity disorder, are more common in children and adolescents with epilepsy. The mental health of parents, parent-child relationships, family functioning, and parental coping styles were adversely affected in families with children with epilepsy. It is essential to evaluate psychiatric comorbidity and family factors in children with epilepsy and to create a treatment plan for problem areas.

The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study.

STUDY DESIGN: Single-blinded, randomized controlled study. INTRODUCTION: Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. PURPOSE OF THE STUDY: This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. METHODS: A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. RESULTS: We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DISCUSSION: This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. CONCLUSIONS: MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.

Are H1 and H3 haplotypes of endothelial protein C receptor (PROCR) an important factor in contracting COVID-19?

The development of cardiovascular disease shows increase after contracting coronavirus 2019 (COVID-19) disease and myocardial damage is observed in patients who have had the disease severely. The relationship between genetic cardiovascular risk factors with COVID-19 infection was investigated in our study. One hundred thirty-five patients, 27 of whom were COVID-19 (-) and 108 were COVID-19 (+) patients, were included in the study. Patients were divided into three groups ([COVID-19 [-], COVID-19 [+] asymptomatic, and COVID-19 [+] symptomatic + patients with pulmonary involvement]). Genetic cardiovascular risk factors were examined in blood samples taken from the patients with new generation sequencing analysis. In the clinical classification, there were no significant differences between the three groups in fibrinogen beta chain-455G>A, human platelet antigen 1 (HPA1b)/platelet receptor GPIIIa/(ITGB3) (HPA1a/b; GpIIIa; integrin beta 3 L33P), ACE I/D, AGT (M268T), AGTR1 (1166A>C), Apo E (E2/E3/E4) (rs7412, rs429358), eNOS (786T>C), eNOS (894G>T) genes (p > 0.05). However, significant differences were observed in PROCR H3 haplotype/G (endothelial protein C receptor gene [EPCR] 4600A>G [A3 haplotype]), PROCR H1 haplotype/C (EPCR 4678G>C [A1 haplotype]) genes (p < 0.05). When COVID-19 (+) and COVID-19 (-) groups were compared, it was observed that the infection was more common in people with PROCR H1 haplotype/C and PROCR H3 haplotype/G genotypes (p < 0.05). PROCR H1 and PROCR H3 haplotypes may be an important factor in contracting COVID-19 disease. In people with COVID-19 disease, revealing PROCR genetic differences and measuring sEPCR levels will be beneficial in the follow-up of the disease.

Analysis of long-term antibody response in COVID-19 patients by symptoms grade, gender, age, BMI, and medication.

The first aim of the study was to analyze the change in antibody titer at 15-day intervals until 60 days postsymptom onset (PSO). The second aim was to analyze the relationship between antibody titer and symptom grade, gender, age, body mass index (BMI), medications, vitamin supplements, and herbal therapies. Blood samples were collected from 43 patients (5 mild, 21 moderate, 17 severe diseases), 18 women (41.9%), and 25 men (58.1%), on 15, 30, 45, and 60 days PSO after COVID-19 infection. The serum antibody titers were determined by measuring the COVID-19 immunoglobulin G (IgG) antibodies by enzyme-linked immunoassay (ELISA). Associations between the duration of symptoms, demographic and clinical parameters, medications and vitamins used, and herbal therapies were evaluated by interviewing the participants. Within the first 15 days of illness, 81.4% of the patients were positive. From Day 45 PSO, seropositivity was 89.5%. The anti-SARS-CoV-2 antibody titers were statistically higher in men than women at all times (p < 0.01). Antibody titer was higher in older participants compared to younger participants (p < 0.02). Plaquenil or favipiravir use did not affect antibody response (p > 0.05). Men had a higher fever (p = 0.006), shortness of breath (p = 0.004), and chest pain (p = 0.03) than women. We found powerful antibody response by 60 days PSO, as well as higher antibody response and severity of symptoms in the men gender. Data also showed that SARS-CoV-2 antibodies are higher in individuals with older age, whereas BMI, concomitant chronic disease, and medications had no effect on antibody titers.

Pilot study of the diagnostic value of CRP:albumin ratio for osteomyelitis in patients with diabetic foot ulcers.

OBJECTIVE: Osteomyelitis may complicate diabetic foot ulcers (DFUs). As a new inflammation-based prognostic factor, CRP:albumin ratio's significance is not known in osteomyelitis among patients with or without diabetes. METHOD: Patients with type 2 diabetes and DFUs were divided into two groups: group 1 (n=47) comprised patients without osteomyelitis, and group 2 (n=50) comprised patients with osteomyelitis. RESULTS: Erythrocyte sedimentation rate (ESR) (88.5±23.0 versus 42.0±22.2), white blood cell count (WBC) (14.7±6.9x103 versus 10.0±4.4x103), C-reactive protein (CRP) level (15.6±9.9 versus 2.4±3.3) and CRP:albumin ratio (6.6±4.9 versus 0.7±1.0) were significantly higher, and albumin level was significantly lower in group 2 compared to group 1 (p<0.001 for all). The presence of osteomyelitis was significantly and positively correlated with ESR (r=0.721; p<0.001), WBC (r=0.380; p<0.001), CRP (r=0.667; p<0.001) and CRP:albumin ratio (r=0.638; p<0.001), and negatively correlated with albumin (r=-0.590; p<0.001). A CRP:albumin ratio of 1.74 or above could predict osteomyelitis with 92.0% sensitivity, 80.9% specificity, and the best area under the curve (AUC) score (AUC=0.957; 95% CI: 0.924-0.991). ESR (odds ratio (OR): 1.071 (1.025-1.119); p=0.02) and CRP:albumin ratio (OR: 2.65 (1.437-4.885); p=0.002) were independent predictors in the final model for stepwise linear regression analyses for the estimation of osteomyelitis. CONCLUSION: CRP:albumin ratio is a cheap and repeatable inflammatory marker and can successfully detect osteomyelitis in patients with DFU.

Sinus Augmentation Using Caldwell-Luc Technique in the Existence of Ectopic Tooth in the Maxillary Sinus: A Multidisciplinary Approach.

Ectopic maxillary third molar teeth can often be located in the maxillary sinus, and the region necessarily requires a multidisciplinary approach due to its proximity to the oral cavity. Ectopic third molar tooth in the maxillary sinus was detected by oral and radiological examination in a 26-year-old male patient. The tooth was removed, and sinus augmentation was performed through the Caldwell-Luc procedure, and a dental implant was placed afterward. The treatment was ended by making a prosthetic metal-supported ceramic crown. Both removals of the ectopic tooth from the maxillary sinus, sinus augmentation, and implant operation can be achieved in a single operation of a single-window opened in the bone. As a result, because of the adjacency of the regions in operations related to the maxillary sinus, both the dental practitioner and the otolaryngologist should evaluate the operation, and multidisciplinary work should be done when necessary.

Thiol-disulphide balance and total oxidant-antioxidant status in patients with chronic hepatitis C.

OBJECTIVE: To assess the dynamic thiol/disulphide homeostasis (DTDH) and total oxidant/antioxidant status in patients with hepatitis C virus (HCV) infection and to evaluate their association with HCV-RNA levels. METHODS: Levels of serum total thiol (TT), native thiol (NT), disulphide (DS), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) as oxidative stress markers were determined in 162 individuals, including 74 patients with HCV infection and 88 non-HCV controls. HCV genotypes and HCV-RNA levels of the patients were recorded. RESULTS: The NT, TT and TAS levels and NT/TT ratio were significantly lower in the HCV group compared with the control group. On the contrary, DS, TOS and OSI levels and DS/NT and DS/TT ratios were significantly higher. Patients with high HCV RNA levels (> 650 000 IU/mL) had higher DS levels than patients with low HCV-RNA levels (<650 000 IU/mL). Genotype 1 was observed in 68.9% of patients with HCV. Levels of oxidative stress parameters were similar between genotype 1 and other genotypes (2, 3 and 5). No significant correlations were found between oxidative stress markers and albumin, alanine aminotransferase, aspartate aminotransferase, bilirubin and HCV-RNA levels in patients with HCV infection. A negative correlation was found only between OSI and albumin. CONCLUSION: Our results suggest that DTDH shifts towards the DS direction because of thiol oxidation in HCV-infected patients. Furthermore, DS levels were significantly higher in patients with high HCV-RNA levels compared with patients with low HCV-RNA levels.

Evaluation of testing and vaccination status of healthcare workers in Turkey for hepatitis A: A multicenter study.

BACKGROUND: This study aimed to investigate the prevalence of the disease and testing and vaccination status of healthcare workers in terms of hepatitis A infection as well as their awareness. This study is a multicenter descriptive study performed with healthcare workers. MATERIAL AND METHODS: Testing status for hepatitis A, awareness of the results and vaccination status of healthcare workers were compared. RESULTS: Of the 12,476 healthcare workers participating in the study, only 65% (8,115 healthcare workers) had awareness of hepatitis A test results. Of the participants, 6,481 (66.3 %) stated that they were not vaccinated against hepatitis A. Vaccination rates against hepatitis A decreased with increasing age (P < .01). The rates of vaccination in all departments where participants worked were above 60% (P < .05). While the rate of protection among those working in departments creating a risk for hepatitis A virus infection was higher, no difference among vaccination rates was observed compared with the other departments. CONCLUSION: Vaccination of seronegative individuals is the safest way for hepatitis A, which can progress to fulminant hepatitis at advanced ages. It must be aimed primarily to increase the awareness of healthcare professionals and to increase the vaccination rates for hepatitis B and hepatitis A for the prevention of viral hepatitis. In our study, the awareness level was found to be above 50%, and the vaccination level was 35%, which is a rate that must be increased.

Fever of unknown origin (FUO) on a land on cross-roads between Asia and Europa; a multicentre study from Turkey.

AIMS: The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicentre study, we aimed to reveal FUO aetiology and factors influencing the final diagnosis of FUO in Turkey. METHODS: A total of 214 patients with FUO between the years 2015 and 2019 from 13 tertiary training and research hospitals were retrospectively evaluated. RESULTS: The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult-onset still's disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The aetiological spectrum did not differ in elderly people (P < .05). Infections were less frequent in Western (34.62%) compared with Eastern regions of Turkey (60.71%) (P < .001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed aetiology was significantly higher in elderly people (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (P: .004, OR: 3.07, 95% Cl: 1.39 to 6.71). CONCLUSIONS: Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumours and lymphomas, AOSD and thyroiditis are the other common diseases. The aetiological spectrum did not differ in elderly people, on the other hand, infections were more common in Eastern Turkey. A considerable amount of aetiology remained undiagnosed despite the state-of-the-art technology in healthcare services.

Vaccination and Immunotherapy for Major Depression.

Depression is a very common disease with increasing incidence resulting from complex interactions of genetic, environmental, and immunological processes. To this day, the etiopathogenesis and treatment of depression unfortunately seem to be stuck in the synaptic gap. Despite highly potent antidepressants, the treatment rate cannot reach 100%, the treatment resistant group cannot be eliminated, and relapse cannot be prevented. These problems lead researchers to further and different research to understand and treat psychopathology. Immune dysfunction and neuroinflammation have been one of the main issues that psychiatry has focused on in recent years and helps us to understand depression. Extraneuronal components of all neuropsychiatric disorders, especially depression, have begun to be revealed in detail thanks to a better understanding of the immune system and an increase in experimental and technological possibilities. There is increasing evidence of a causal relationship between the etiopathogenesis of major depression and low-level chronic neuroinflammation. In this article, the role of neuroinflammation in the etiopathogenesis of depression and the possibilities of vaccination and immunotherapy are discussed.

Immune-Kynurenine Pathways and the Gut Microbiota-Brain Axis in Anxiety Disorders.

Anxiety disorders are a complex set of illnesses in which genetic factors, particularly stress, play a role in the etiopathogenesis. In recent years, inflammation and intestinal microbiota have also been included in this complex network of relationships. The functions associated with tryptophan catabolism and serotonin biosynthesis have long been associated with anxiety disorders. Tryptophan catabolism progresses toward the path of the kynurenine in the presence of stress and inflammation. The catabolism of kynurenine is a pathway in which many enzymes play a role and a large number of catabolites with neuroactive properties occur. The body's serotonin biosynthesis is primarily performed by enterochromaffin cells located in the intestines. A change in the intestinal microbiota composition (dysbiosis) directly affects the serotonin biosynthesis. Stress, unhealthy nutrition, and the use of antibiotics cause dysbiosis. In the light of this new perspective, the role of dysbiosis-induced inflammation and kynurenine pathway catabolites activated sequentially come into prominence in the etiopathogenesis of anxiety disorders.

The therapeutic efficacy of dexpanthenol on sciatic nerve injury in a rat model.

Objective: The aim of this study was to evaluate histopathological, functional and bone densitometry examinations of the beneficial effects of dexpanthenol (DEX) on nerve regeneration in a rat model of peripheral nerve crush injury.Methods: Thirty adult Sprague-Dawley rats were divided equally into three groups. A crush injury was simulated in all rats by clamping the right sciatic nerve for one minute. In group 1, one day before the surgical procedure, 500 mg/kg DEX administered via intraperitoneally (ip) was initiated and continued three times in a week during the experiment period as 28 days. In group 2, rats received a dose of 10 mg/kg DEX to investigate possible effects of DEX alone. Group 3 served as the control (sciatic nerve injury) and was not given any drugs.Results: Performance was significantly lower in group 3 compared to the drug treatment groups during the rotarod test (30 rpm and 40 rpm) (p < 0.05). After a while, the rats which were able to remain on the rod was significantly lower in group 3 during the acceleration test (p < 0.05). Hot plate latency test results in group 3 were significantly lower when compared to the other groups (p < 0.05).Conclusion: DEX appears to be useful as a supportive clinical agent for the treatment of pain and nerve damage.

Psychobiotics.

Psychobiotics are live bacteria that directly and indirectly produce positive effects on neuronal functions by colonizing into the intestinal flora. Preliminary studies, although in limited numbers, have found that these bacteria have anxiolytic and antidepressant activities. No research has yet been published on the antipsychotic efficacy of psychobiotics. However, these preliminary studies have opened up new horizons and raised the idea that a new class is emerging in psychopharmacology. About 70 years have passed since the discovery of chlorpromazine, and while the synaptic transmission is understood in almost all details, there seems to be a paradigm shift in psychopharmacology. In recent years, the perspective has shifted from synapse to intestinal microbiota. In this respect, germ-free and conventional animal experiments and few human studies were examined in a comprehensive manner. In this article, after a brief look at the history of contemporary psychopharmacology, the mechanisms of the gut-brain relationship and the evidence of metabolic, systemic, and neuropsychiatric activities of psychobiotics were discussed in detail. In conclusion, psychobiotics seem to have the potential for treatment of neuropsychiatric disorders in the future. However, there are many questions and we do not know the answers yet. We anticipate that the answer to these questions will be given in the near future.

Outcomes of Endoscopic Powered Revision Dacryocystorhinostomy.

Objective of this study is to determine the etiology of patients applied with revision endoscopic dacryocystorhinostomy (DCR) and to evaluate the operation results.The patients were retrospectively evaluated in respect of demographic data, the time from primary to revision surgery, revision etiology, the use of bicanalicular silicone nasolacrimal tube (BNLT), the time to postoperative removal of the silicone tube, and the success of the revision surgery.The study included 27 patients applied with revision endoscopic DCR between January 2013 and January 2016. The mean age of the patients was 46.7 ±â€Š11.7 years. The mean time from the first operation to revision surgery was 7.2 ±â€Š6.1 months (range, 1-24 months). During the endoscopic DCR, synechia was observed in 2 (7.4%), granulation tissue in 7 (25.9%), inadequate bone window in 5 (18.52%), and membranous scar around the ostium in 22 (81.4%) patients. More than 1 etiologic problem was determined in 8 patients. During the revision procedure, BNLT was applied to 12 (44.4%) patients. At the final follow-up examination, the complaint of epiphora had completely recovered in 18 (66.6%) patients and there were in 9 (33.3%) patients. The mean time to removal of the BNLT was 1.7 ±â€Š0.57 months (range, 1-3 months).The most common cause of recurrent epiphora in endoscopic DCR was the formation of membranous scar. The use of the mucosal flap technique in primary surgery and the application of BNLT to all patients in revision surgery may increase the functional success rate.

Neural synchronization as a hypothetical explanation of the psychoanalytic unconscious.

Cognitive scientists have tried to explain the neural mechanisms of unconscious mental states such as coma, epileptic seizures, and anesthesia-induced unconsciousness. However these types of unconscious states are different from the psychoanalytic unconscious. In this review, we aim to present our hypothesis about the neural correlates underlying psychoanalytic unconscious. To fulfill this aim, we firstly review the previous explanations about the neural correlates of conscious and unconscious mental states, such as brain oscillations, synchronicity of neural networks, and cognitive binding. By doing so, we hope to lay a neuroscientific ground for our hypothesis about neural correlates of psychoanalytic unconscious; parallel but unsynchronized neural networks between different layers of consciousness and unconsciousness. Next, we propose a neuroscientific mechanism about how the repressed mental events reach the conscious awareness; the lock of neural synchronization between two mental layers of conscious and unconscious. At the last section, we will discuss the data about schizophrenia as a clinical example of our proposed hypothesis.

Affect development as a need to preserve homeostasis.

In this review, we aim to present our hypothesis about the neural development of affect. According to this view, affect develops at a multi-layered process, and as a mediator between drives, emotion and cognition. This development is parallel to the evolution of the brain from reptiles to mammals. There are five steps in this process: (1) Because of the various environmental challenges, changes in the autonomic nervous system occur and homeostasis becomes destabilized; (2) Drives arise from the destabilized homeostasis; (3) Drives trigger the neural basis of the basic emotional systems; (4) These basic emotions evolve into affect to find the particular object to invest the emotional energy; and (5) In the final stage, cognition is added to increase the possibility of identifying a particular object. In this paper, we will summarize the rationale behind this view, which is based on neuroscientific proofs, such as evolution of autonomic nervous system, neural basis the raw affective states, the interaction between affect and cognition, related brain areas, related neurotransmitters, as well as some clinical examples.

A case of galactorrhea during paroxetine treatment.

Paroxetine is one of the selective serotonin reuptake inhibitor antidepressant drugs. Galactorrhea can be seen during antidepressant treatments. There are a few reports in literature on paroxetine use and related prolactin level changes. We present a case that was receiving paroxetine in whom despite low blood levels of the drug, hyperprolactinemia, and galactorrhea was found. We present a case that was receiving paroxetine despite low drug blood levels, hyperprolactinemia, and galactorrhea was found in this article.

The Contribution of the Cerebellum in the Hierarchial Development of the Self.

What distinguishes human beings from other living organisms is that a human perceives himself as a "self". The self is developed hierarchially in a multi-layered process, which is based on the evolutionary maturation of the nervous system and patterns according to the rules and demands of the external world. Many researchers have attempted to explain the different aspects of the self, as well as the related neural substrates. In this paper, we first review the previously proposed ideas regarding the neurobiology of the self. We then suggest a new hypothesis regarding the hierarchial self, which proposes that the self is developed at three stages: subjective, objective, and reflective selves. In the second part, we attempt to answer the question "Why do we need a self?" We therefore explain that different parts of the self developed in an effort to identify stability in space, stability against constantly changing objects, and stability against changing cognitions. Finally, we discuss the role of the cerebellum as the neural substrate for the self.